Innovations on the horizon
Marcus Clark and St John Brown
Co Directors Prostate Matters
This page represents what we believe to be the most exciting Innovation in treating prostate disease developments in the diagnosis, treatment and management of prostate disease.
We are focusing on three topics.
- The Prostogram trial which is pursuing the goal of a screening test for men which would be the equivelant of the mammogram screening for breast cancer and would revolutionise early detection and treatment.
- AI in detecting and reporting cancer from MRI. In this context Lucida Medical have developed Multi-stage AI analysis system to support prostate cancer diagnostic MR imaging
- New Focal Therapy technologies for minimally invasive treatment. As well as HIFU, Cryotherapy and Nano knife, there are several new technologies not yet in clinical use in the UK. These include, Francis Medical’s Transurethral thermal water vapour ablation, MR guided transurethral ultrasound ablation (TULSA -PRO) for cancer and BPH from Profound Medical and Focal Laser Ablation (FLA) of prostate cancer. Their is a link to the latest outcomes study for laser treatmemts which is very encouraging.
- Benign Prostatic Hyperplasia. A new trial testing a drug coated balloon catheter.
Following a successful pilot study, the ongoing randomized PINNACLE trial is aiming to confirm the safety and efficacy of the Optilume. Results from the EVEREST-1 pilot study (NCT03423979) presented at the 2020 American Urological Association Virtual Experience showed that Optilume is safe and provides significant improvements in BPH-related lower urinary tract symptoms.
Lucida Medical have developed Multi-stage AI analysis system to support prostate cancer diagnostic MR imaging
As illustrated by the following graph:
These example outputs show patients with a biopsy verified Gleason score >=3+4 cancer
In terms of men’s health, the success of the Prostogram trial and its subsequent adoption would represent the biggest step change in the management of men’s health in fifty years.
A short MRI scan could be the future for how doctors screen for prostate cancer. This new scan or ‘Prostagram’ could be a step towards a national screening programme for prostate cancer. The approach would be similar to mammograms which are offered to women to screen for breast cancer.
The Prostagram is a simple 15 minute scan which uses magnetic waves that have no radiation risk to produce a detailed picture of the prostate making it safe as well as non-invasive. It is a shorter version of the full 40 minute MRI scan which has recently been recommended by the National Institute for Health and Care (NICE) for use in men already referred to hospital by their family doctor.
Researchers at Imperial College London have successfully piloted the Prostagram and initial results suggest that it may be better than PSA (prostate specific antigen) blood test at detecting the earliest signs of prostate cancer.
Over the last decade, there has been increasing evidence that PSA is not accurate enough to be a screening test for prostate cancer – it can miss dangerous tumours but also tends to find slower growing low risk cancers which don’t cause harm or shorten life. This means that men can be unnecessarily subjected to the harm of a cancer diagnosis and side effects from treatment without any survival benefit so PSA has not been recommended as a national screening test.
PSA is also often accompanied by an internal rectal examination. This can help identify a lump in the prostate with cancer but can put off some men from seeking medical advice for prostate issues because they are worried about embarrassment or discomfort.
Meanwhile, the number of men dying from prostate cancer have overtaken breast cancer and we think it is important to support the work of researchers developing new ways to screen for prostate cancer.
“Prostagram has the potential to form the basis of a new screening programme for prostate cancer and could be a game-changer,” says Professor Hashim Ahmed, Chair of Urology at Imperial College London who led the first study of Prostagram. “The number of aggressive prostate cancers missed by PSA highlights the importance of ramping up our research efforts into alternative ways to screen for prostate cancer.
The Prostagram has been tested on over 400 men between 50 and 69 years within a clinical trial. The volunteers received both a Prostagram and PSA test which allowed researchers to compare the accuracy of each test. The findings suggest that Prostagram may be better at uncovering aggressive prostate cancer which is missed by PSA. The results were presented at the prestigious American Society of Clinical Oncology (2020) Annual Meeting in Chicago, USA on Friday 29 May 2020.
For more information visit the Prostagram page
Prostate matters is a not for profit organisation that is committed to providing free expert advice about prostate issues from leading Clinical Authorities
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